Trinity Student Medical Journal 2003

My Experiences on the Peer Support Programme

Christopher Dardis, 5th year Medicine

“Just listen”…That is written on the walls of the Adelaide and Meath Incorporating the National Children’s Hospital (AMNCH) in Tallaght, and so I thought I was doing reasonably well until I decided to embark on the 30 hour ‘Peer Support Programme’ run by the Student Counselling Service in Trinity. Although I had not done psychiatry, where so much emphasis is placed on interpreting the patient’s speech in form and content as well as the nonverbal indications of affect they give, nor the general practitioner (GP) course where there are exercises on communication skills, I did have a wan memory of one lecture on the importance of eye-contact and body language. So until this, I had mostly been following a routine set of standard questions in my history taking. This usually worked fine for diagnosis, but I was aware that the responses to open-ended questions like “How are you?’” and ”Is there anything else you’d like to tell me about/ask me?” sometimes left me wondering if I had responded to their answers in the appropriate way. I knew that there were times I felt I had shifted topics too quickly, and that I would have liked to have spent more time on something the patient said.

This programme is now in its second year in college. It was implemented when a postgraduate in the TCD psychology department , concerned about ‘drop-out’ rates, showed that those who leave college before graduating or those with personal problems generally feel more comfortable talking to a peer than someone in authority on campus. Similar programmes have been run in colleges in the UK and USA with successful results. The peer support groups are backed-up by the counselling service if they feel that they are getting out of their depth, and they learn when and how to refer students who need more expert help. They help the students with  their needs, including issues like adjusting to a new lifestyle, getting to know the city, culture, clubs and societies.   In addition they try to help with relationship difficulties and issues relating to personal identity.  

So down we sat, about 12 of us, all strangers.  We were a diverse group which included 20 year old 2nd year students, postgraduates, middle-aged mature students, foreigners and Trinity Access Programme students. Almost everyone was doing a different degree. Most of us had little or no knowledge of counselling or psychology, and this proved quite irrelevant. In fact, one postgraduate psychology student was surprised how unprepared he was for the practical application of many theories with which he was familiar. One would think that with all the time one spends talking, there would not be much to learn. Even with the first exercises, like describing the journey into college that day, there was plenty to pick up on. Eye contact -  we all know that. Nodding? Affirmation? Mirroring body language? Prompting? Summarising the other’s thoughts to the class afterwards (no notes here)?  Talking about times when someone listened well or badly to us, and the qualities that that person displayed while listening to us, was revealing.  Also, thinking about social support and about ‘owning’ our statements (i.e. "You were acting like a fool" versus "I was concerned about your behaviour") was enlightening. We reflected on the difference between empathy and sympathy, the former essential if you want to help, the latter often getting in the way. Suspending (or ‘bracketing’) my emotions was something I realised I was doing unconsciously while talking to patients and was not always successful in doing so. I found this particularly when I first started to take histories. For example, when listening to stories of a particularly harrowing nature, or when something the patient said struck me as funny even though they did not intend it to be so, I became so caught up with emotion that I would forget the next question I had in mind or found an unexpected desire to laugh out loud.

We learned basic counselling skills, based on the premise that the student being counselled will have the answers to his personal problems within thim. Often the solution is to draw the problem out by reflecting, paraphrasing and summarising students’ implicit or explicit thoughts, feelings and behaviour, and using silence, open and closed questions and giving our own position at the appropriate time. Reading into their values, motivations and central concerns was challenging. We moved from trivial examples to 20-minute role-play situations, where the latter dealt with more serious issues, including some warranting more expert help. We reflected on our prejudices, issues about which we were ignorant or uncomfortable and limits of competence and confidentiality, and how this could get in the way of aiding someone. It sounds artificial, but these do not seem like the kind of skills that one learns when left to one’s own devices – although it sometimes seems like we are supposed to in medicine! None of us had the expression ‘How did that make you feel?’ as part of our vocabulary, and while it might sound clichéd, I haven’t found anyone cringing or grimacing yet when it appears in conversation. Everyone got the hang of it but we all found it much harder in practice than print.

It certainly provided food for thought.  All participants felt that in their everyday lives they were not approaching listening with anything like the awareness and range of techniques that we were learning. Particularly I felt this to be the case with my friends and family – I noticed myself being ‘triggered’ and preparing my own point before they had finished, although I do not think any of them have noticed any difference. The counsellors running things had a way about them to which a few of us were new.  We would find ourselves being drawn into making comments without expecting it. It also made me think about examples in hospital of times when communication went awry without the doctor’s knowledge.  On a few occasions I felt that the patient’s anxiety about his condition was not acknowledged by a busy, efficient, heroic, ‘we’re doing the best we can’ attitude.  I realised that I had had this same attitude myself at times. It also made me aware of times when great skill and attention was employed in drawing out a young man with Down’s syndrome or an elderly woman suspected to be depressed, who initially felt insulted and angry at the suggestion but went on to recognise that she could do with help.

On the down side, some of us on the programme now found that when we were feeling blue and wanted to air our thoughts that we were not being listened to as well as we would have liked by our friends and family! However, I found I could sometimes put the techniques into practice in my own internal dialogue.

Many in the group thought these skills were important enough to be taught on their course, if not in secondary school. This was particularly so for some studying social work and those doing qualitative research with semi-structured interviews in sociology. I certainly felt it could be a useful addition to our course, especially for those 5th years engaged in ‘mentoring’ freshman medics – an initiative which received commendation from the Counselling Service, who is trying to set up similar arrangements in other faculties. Its relevance to clinical practice seems to be getting more recognition, with one medical degree in the UK spending one fifth of the time over four years devoted to communication skills. Despite there being no obligation, many of us went on to volunteer in the programme in college and will hopefully be putting some of this to good use. They plan to run another training session next year and I highly recommend it!

REFERENCES

Peer Helper Programme: an indepth look at peer helping: planning implementation and administration. Bristol: Accelerated Development.

Brown L. Counselling skills at work : 20 tried and tested activities for developing practical counselling skills. Ely:Fenman Limited, 1998.